Onyx液态栓塞剂治疗高级别脑动静脉畸形的临床体会

目的 探讨高级别(Spetzler-Martin Ⅳ～Ⅴ级)脑动静脉畸形(AVMs)治疗中Onyx液态栓塞剂的方法和作用.方法 回顾性分析32例高级别AVMs运用Onyx治疗的临床资料,并对高级别AVMs的手术适应证以及手术方法的选择加以讨论.结果 运用Onyx液态栓塞剂治疗26例高级别AVMs,经过血管内栓塞治疗后完全栓塞13例,大部栓塞10例,不全栓塞3例.其中10例经过手术和(或)放射治疗,随访期间,全脑血管造影检查提示动静脉闭塞23例;26例患者恢复良好,术后出血2例,未见新的神经功能损害出现,无死亡病例.结论 对于高级别AVMs,首选用Onyx液态栓塞剂治疗,采用微导管超选到位、控制性注射以及对静脉的保护,可以改善高级别AVMs的疗效.

Treatment of high grade cerebral anteriovenous malformations with Onyx embolic agent

Objective To investigate the application of Onyx in the treatment of cerebral AVMs on Spetzler-Martin grade Ⅳ～Ⅴ. Method 32 cases of cerebral AVMs on Spetzler-Martin grade Ⅳ～Ⅴ were treated with Onyx, and ten of them were combined with microsurgical resection and stereotactic radiosurgery,then the indications and approaches of high grade AVMs were analyzed retrospectively. Results 26 cases were underwent intravascular embolization. Among them, 13 cases were totally occluded with Onyx, 10 cases were subtotally occluded and 3 cases were partially embolized. 10 patients were treated combining with micrnsurgical resection and stereotactic radiosurgery. Cerebral hemorrhage occurred in 2 cases and no new nerve system deficits appeared in follow-up, no case died. Conclusions Onyx is a safe and effective liquid embolic agent for use in the treatment of cerebral AVMs on Spetzler-Martin grade Ⅳ～Ⅴ. Superselective intranidal catheter positions and slow, controlled injections that protect the draining veins make the therapy safe in high grade of AVMs.